A systematic evaluation of the differential effectiveness of brief alcohol interventions with injured patients at various stages of change is needed. Several randomized trials of brief alcohol interventions have been conducted with injured patients (Bazargan-Hejazi et al, 2005;Gentilello et al.,1999;Longabaugh et al., 2001;Monti et al.,1999, Mello et al, 2005). In general, these studies demonstrate that brief alcohol interventions with injured patients may effectively reduce alcohol intake and related consequences, including injury recidivism. However, a single brief intervention with injured patients has not proven effective with all patient populations presenting for treatment of an alcohol related injury. As suggested by current research, some injured patients may need a booster session to achieve positive treatment outcomes and others may require referral for additional treatment. The need for intervention at different levels of intensity may be associated with the client's readiness or stage of change. This proposal hypothesizes that the necessity of a booster session is dependent upon the patient's motivation to change their drinking behavior at the time they present for treatment of an alcohol related injury. Further, the currently proposed study will extend current findings regarding brief intervention with injured patients to include an evaluation of the treatment referral and harm reduction components. Subsequent treatment utilization is a particularly important outcome of interest among patients with alcohol dependence and comorbid disorders including drug dependence or depression as well as those with psychosocial problems such as homelessness. Prior studies of brief intervention with injured patients have excluded patient groups with comorbid psychosocial problems and found limited effectiveness among patients with severe alcohol problems. As a result, the generalizibility of findings to adult injured patients may be limited and the effectiveness of this approach in the broader population of injured patients remains unknown. By addressing the key issues described above, this study will consolidate and expand our current understanding regarding the utility of various brief intervention strategies with injured patients and will significantly enhance the clinical effectiveness and generalizability of current findings.